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General NPI Number Information
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NPI Number | 1740532167
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Entity Type | Individual
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Provider Name | DANIEL A CHAMPAGNE LAT
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Gender | Male
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 1400 NW AVENUE K
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City | ANDREWS
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State | TX
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Zip | 79714-3860
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Country | US
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Telephone | 432-524-1973
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Fax | 432-524-1973
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Provider Business Mailing Address
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Address Line | 405 NW 3RD ST
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City | ANDREWS
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State | TX
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Zip | 79714-5014
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Country | US
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Telephone | 432-523-3640
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Fax | 432-524-1973
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT4922
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License Number State | TX
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